Bullying Syndrome? How Maltreatment Affects Health

Awareness of bullying has grown in recent years. But while the common images of bullying — kids shoved against lockers, and "mean girls" slinging gossip — emphasize bullying as a social ill, medical professionals increasingly see bullying as a public health issue.

Dr. Jorge Srabstein, medical director of the Clinic for Health Problems Related to Bullying at the Children's National Medical Center (CNMC), has long emphasized bullying's very real physical and psychological health effects. "Bullying is linked to a wide range of health issues, both physical and emotional symptoms," said Srabstein, who has both studied the issue and treated thousands of children in his practice.

Those bullied and their bullies alike complain of headaches and stomachaches, have difficulty falling asleep and fall victim to psychological symptoms, most notably depression and "very significant anxiety," Srabstein said.

Interestingly, symptoms associated with bullying tend to appear in a cluster — that is, people affected by bullying don't often only get headaches. Instead, they get headaches accompanied by anxiety, stomachaches and depression, Srabstein said.

This clustering grants the appearance of a medical syndrome, Srabstein said, though there's not yet enough evidence to declare a "bullying syndrome." CNMC estimates 10 percent of U.S. children suffer this cluster of symptoms. Between 1 in 3 to 1 in 4 U.S. students report being bullied, according to the U.S. Department of Health and Human Services. [10 Scientific Tips for Raising Happy Kids]

A public health issue

That cluster of symptoms has caught the attention of public health officials, physicians and other health care providers, said Julia Hertzog, director of the PACER National Bullying Prevention Center. Her organization, which advocates for children with disabilities, has received an increasing number of requests to educate health providers on recognizing, treating and preventing bullying, she said.

Health professionals can help in the fight against bullying in three main ways, Srabstein said: First, by contributing to community and school programs to increase awareness of bullying, thus promoting a more respectful environment. Such programs have too often left out public health officials, Srabstein wrote in a WHO statement.

But these programs, while essential, can only cut bullying behavior by about 40 percent, so health professionals must contribute in a second way: identifying bullying when it happens, Srabstein said. (Some studies show more modest effects for certain programs.) PACER helps hospitals and clinics incorporate bullying-related inquiries into their standard sets of health questions. Doctors might, for instance, routinely ask children if they feel safe at school.

Providers should share any evidence of bullying with parents, and suggest raising the issue with the school, Hertzog said.

Srabstein likens this medical campaign to historical examples of public health monitoring. "In the same way that schools have had to identify public health issues like the measles or curvature of the spine," schools and doctors need to work together to find signs of bullying, he said.

Treating bullied kids

But even public-health vigilance won't eliminate all cases of bullying, so health officials must make their third contribution, Srabstein said: treating the symptoms of bullying.

That means addressing headaches and stomachaches, but also the depression and anxiety that bullying entails. Psychological problems are particularly important, as victims and perpetrators alike face higher risks of self-harm, substance abuse and suicide, Srabstein said. A Yale study showed that bullying victims are two to nine times more likely to report thoughts of suicide compared with children who haven't been bullied.

"They are at a significant risk of hurting themselves," Srabstein said. "So, bullying is highly associated with suicide risk."

Reports and studies on bullying have increased over the last two decades, Hertzog said. The just-completed National Bullying Prevention Awareness Month, created in 2006 by PACER, received White House support at the end of October.

The ongoing, increased attention for bullying should bring better understanding of the issue, too, Srabstein said. Both health professionals and the general public need to recognize that bullying can affect many different segments of society, not only students, he said.

"It's not an issue that just pertains to children in school," Srabstein said. Bullying can also affect children in the home, adolescents in relationships and even adults in the workplace, he said. "Bullying is a multifaceted form of maltreatment … It occurs across the world and across different social settings."

For advice on preventing bullying, recognizing the signs and responding to cases of such maltreatment, visit CNMC's fact sheet or the Department of Health's bullying site.